1. Gastro-oesophageal Reflux Disease (GORD) and Gastritis

📄Definition 

GORD: is a chronic condition where gastric acid refluxes into the oesophagus causing troublesome symptoms (e.g. heartburn) or complications (e.g. oesophagitis).

Gastritis: refers to inflammation of the gastric mucosa (acute or chronic) due to infection, irritants, autoimmune causes, or systemic disease.

🛡️ Aetiology / Risk Factors

SharedGORD-specificGastritis-specific
SmokingHiatus herniaHelicobacter pylori infection
Alcohol / caffeine / acidic foodsPregnancyAutoimmune gastritis (anti-parietal cell / IF Ab)
Drugs (NSAIDs, aspirin, steroids, CCBs)  
Elevated BMI (obesity) Irritants: spicy food
  Nicotine
  Associated with GORD

🤒Clinical Features 

GORD – HEARTBURN

  • Heartburn – retrosternal burning, worse after meals/lying flat
  • Epigastric pain
  • Acid taste / regurgitation
  • Relieved by antacids
  • Troublesome cough (night)
  • Bloating
  • Unexplained dental erosions
  • Repeated sore throat
  • Nausea/vomiting

Gastritis – PAINED

  • Post-prandial epigastric pain
  • Anaemia (chronic blood loss)
  • Indigestion / dyspepsia
  • Nausea/vomiting
  • Early satiety / bloating
  • Dark stools (melaena) in haemorrhagic cases

🚩OGD Referral Criteria

1️⃣ Urgent — 2-Week Wait (ALARM55)

Urgent referral for OGD (oesophagogastroduodenoscopy) (2WW) if:

  • Anaemia (iron deficiency)
  • Loss of weight (unintentional)
  • Anorexia
  • Recent onset dysphagia
  • Melaena / haematemesis
  • 55 years or older with new symptoms

2️⃣ Non-Urgent OGD — Barrett’s Risk Assessment

Consider non-urgent endoscopy for patients with GORD symptoms + multiple Barrett’s risk factors, even without red flags:

  • Chronic GORD symptoms (>5 years)

  • Age ≥50

  • Male sex

  • White ethnicity

  • Central obesity (waist circumference / BMI ↑)

  • Smoking history

  • First-degree relative with Barrett’s oesophagus or oesophageal adenocarcinoma

Purpose: Detect and confirm Barrett’s early for surveillance.

🔬 Investigations

Test Indication Notes
Clinical diagnosis Typical symptoms, no red flags Empirical treatment appropriate
OGD ≥55y + new symptoms • Alarm features • Poor treatment response Biopsy if Barrett’s suspected
pH monitoring / manometry Diagnosis uncertain after OGD Useful for surgical planning
H. pylori testing See treatment ladder Stop PPI ≥2 weeks prior

1️⃣📍Initial Assessment

  • Exclude red flags (↑ → urgent OGD)

  • Assess NSAID, alcohol, smoking use

  • Consider overlap with PUD or functional dyspepsia

2️⃣ First-line in No Red Flags

  • Lifestyle changes (see management)

  • Empirical PPI trial – omeprazole 20 mg OD for 4 weeks

3️⃣🧫 H. pylori Testing — When to Test?

✅ Test for H. pylori if:

  • Un-investigated dyspepsia (especially <55 years and no red flags)
  • Symptoms persist after PPI trial
  • Previous history of gastric/duodenal ulcer or gastritis
  • Planned long-term NSAID use, especially in patients >45 years
  • Known iron-deficiency anaemia, or ITP/B12 deficiency
  •  

❌ Do not routinely test:

  • Asymptomatic, no ulcer history or risk factors

  • During/within 2 weeks of PPI use

  • If alarm symptoms present → refer OGD

💡 PARA Tip:

PPIs must be stopped ≥2 weeks before urea breath test or stool antigen — common exam trap.

 4️⃣🧪 H. pylori Testing — Which Test to Use?
Test When to Use Notes
Urea Breath Test 1st-line Stop PPI ≥2 wks before
Stool Antigen Test 1st-line Preferred in primary care
Serology Avoid Cannot distinguish past vs active infection
OGD + biopsy Red flags / failure Also rules out malignancy & ulcers

5️⃣ 🔁Follow-Up

  • Confirm eradication 4 weeks after completing triple therapy (if given) using urea breath test or stool antigen — not serology.

🔎 Summary for PARA:

Test H. pylori in persistent dyspepsia without alarm features. Use stool antigen or breath test (PPIs stopped 2 weeks prior). Do not test if alarm symptoms present — refer for endoscopy.

📋 Management — 

1️⃣ Lifestyle & PRN Relief

  • Weight loss, smoking/alcohol cessation, avoid trigger foods/drinks, smaller frequent meals, avoid lying after eating, raise head of bed.

  • PRN antacids/alginates (e.g. Gaviscon Advance).

2️⃣ Standard PPI Trial

  • Omeprazole 20 mg OD × 4–8 weeks.

  • PHE advice: In uncomplicated dyspepsia, test for H. pylori after PPI trial (low UK prevalence <15%).

  • If improved → step down to lowest effective dose/on-demand.

Breakthrough Symptoms

  • Check adherence & lifestyle.

  • Offer PRN antacids between PPI doses.

  • If persistent → double PPI dose or trial alternative PPI.

3️⃣ Step-Up or Alternative

  • Double PPI dose (e.g. omeprazole 20 mg BD).

  • Switch to alternative PPI.

  • Add H2RA (e.g. famotidine) if PPI not tolerated.

4️⃣ H. pylori Eradication (if positive)

  • Triple therapy: PPI + amoxicillin + clarithromycin/metronidazole × 7 days.

  • Confirm eradication after 4 weeks (off PPI ≥2 weeks).

5️⃣ Refractory / Severe

  • OGD to rule out malignancy, Barrett’s, ulcers.

  • Consider surgical fundoplication for GORD if severe & PPI-resistant.

  • Manage autoimmune gastritis (lifelong B12 if pernicious anaemia).

⚠️ Complications 

GORD – Mnemonic: BEACH

  • Barrett’s oesophagus

  • Esophagitis

  • Anaemia

  • Carcinoma (adenocarcinoma risk)

  • Haematemesis

Gastritis – Mnemonic: BAGS

  • Bleeding 
  • Anaemia
  • Gastric atrophy 
  • Stomach cancer

🔎 Barrett’s Oesophagus (Key Complication)

  • Metaplasia: squamous → columnar epithelium

  • Risk of oesophageal adenocarcinoma

  • OGD surveillance with biopsies

  • Dysplasia: consider RFA or endoscopic resection

🔎 Last updated in line with:

  • NICE NG1 (Gastro-oesophageal reflux disease in children and young people: diagnosis and management) – Published Jan 2015 • Last updated Oct 2019

  • NICE CKS (Dyspepsia – acute and chronic) – Published May 2010 • Last updated Apr 2023
    Last reviewed: August 2025
    PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success

Scroll to Top